The instant invention relates to medical instruments, and more particularly to an endoscopic device which is receivable in a patient for viewing internal organs therein, and for performing diagnostic and/or surgical procedures on the patient.
The use of various types of endoscopic devices for performing diagnostic and/or surgical procedures on various parts of the human body has been generally known in the medical field for a number of years. Further, it has been generally recognized that many times treatments which are performed on patients utilizing endoscopic devices cause substantially less trauma to the patients than similar treatments which are carried out utilizing conventional surgical procedures. Although some types of procedures which are carried out utilizing endoscopic devices do require relatively minor incisions to be made in patients in order to gain access to certain organs, many other procedures can be carried out through the normal body cavities and require little or no cutting of tissue, so that frequently they can be performed without causing any significant tissue damage. In contrast, corresponding procedures which are carried out utilizing conventional surgical techniques frequently require large incisions to be made in patients, and this obviously causes substantial tissue damage and substantially increases both the trauma and risks to the patient.
Generally, most endoscopic devices comprise a tubular outer sheath which has distal and proximal ends and which is receivable in a patient so that the distal end is located adjacent an area of the body of the patient to be treated or observed, and a telescope portion which is received in the sheath for viewing the area of the patient adjacent the distal end of the sheath. Preferably, a device of this type also includes means for irrigating and draining the area of the body of the patient adjacent the distal end so that clearer viewing of this area can be provided with the telescope portion. Further, in many cases, a device of this type may also include one or more appliances which are receivable in the sheath and are operable from a point adjacent the proximal end thereof for carrying out surgical procedures in the area of the body of the patient adjacent the distal end of the sheath. Although in some cases minor incisions must be made in patients in order to install endoscopic devices therein, in many cases, devices of this general type can be installed in patients without making incisions. For example, when performing diagnostic and/or surgical procedures in the lower urinary tract, an endoscopic device can generally be installed in a patient through the lower urinary tract itself, and hence an incision to accommodate the device is not necessary. In this connection, reference is made to the applicant's co-pending U.S. Pat. Application Ser. No. 525,620 entitled Ureteroscope, wherein an endoscopic device which is adapted for use in performing procedures in the ureter is disclosed and the operating procedures therefor are generally described. On the other hand, when treating and/or diagnosing disease processes in other organs which are not accessible from the body cavities, minor incisions must be made in order to install endoscopic devices, although generally, the incisions which are required to accommodate devices of this type are relatively small so that the trauma to a patient can nevertheless be minimized.
After an endoscopic device has been installed in the body of a patient, unimpaired direct visualization of the areas of the body adjacent the distal end of the sheath of the device is important for the effective performance of both surgical and diagnostic procedures. In many cases, particularly during surgical procedures, blood, mucus and other fluids in the area adjacent the distal end of the sheath of an endoscopic device can severely limit and impair the visibility which can be achieved with the telescopic portion of the device. Hence it is important that, whenever possible, effective irrigation and drainage be provided in the areas being treated in order to provide optimum visibility. In addition, however, it is also important that the irrigation and drainage of these areas be precisely controlled in order to avoid causing damage to the organs or tissue in these areas. In this regard, many conventional endoscopic devices have included means for effecting irrigation and drainage through the sheath portions thereof. They have also included both irrigation and drainage valves adjacent the proximal ends of the sheaths thereof, which are separately connectable to irrigation and drainage systems for supplying irrigation solutions to the instruments and for draining fluids therefrom. Unfortunately, however, the irrigation and drainage valves which have been utilized in conventional devices of this type have generally required substantial amounts of manipulation by operators thereof in order to effect irrigation and drainage, and hence it has generally been difficult to precisely control the amounts of fluids which are passed into or removed from the areas being treated utilizing devices of this type. This is particularly significant when it is recognized that in most cases the attention of operators of devices of this type must be constantly directed to the areas being treated and cannot safely be interrupted for the performance of mechanical manipulations, such as the opening and closing of drainage and irrigation valves.
While it is important that endoscopic devices include some means for effectively irrigating and draining fluids from areas of the body upon which surgical procedures are being carried out, a particular problem is presented when carrying out surgical procedures in the ureter. In this regard, unlike the bladder, the kidney and the ureter have limited volume capacities, and the kidney is very susceptible to injury from excess fluid volume and pressure. Nevertheless, it is generally necessary to irrigate and drain the ureter and kidney during endoscopy, particularly when surgical procedures are involved, because of the problems of visual impairment due to blood, mucus or debris due to pathological processes. Hence, while it is generally necessary to pass fluids into and out of the ureter and kidney during the performance of endoscopic procedures therein, the quantities of fluids which are passed into and out of the ureter and kidney must be precisely controlled in order to avoid serious damage to the ureter and/or the kidney.
The instant invention provides an effective endoscopic device which can be embodied in various forms for endoscopy of various parts of the human body, including the ureter, and it includes means for effectively controlling the irrigation and drainage of fluids in the area of the body being treated. In this regard, the endoscopic device of the instant invention comprises an elongated tubular endoscopic sheath having distal and proximal ends, telescope means received in the sheath and operative from a point adjacent the proximal end of the sheath for viewing an area adjacent the distal end of the sheath, and a three-way valve mounted on the sheath adjacent the proximal end thereof. The sheath is dimensioned to be received in an area of the human body for performing an endoscopic procedure, and it is operative for conducting fluids from a point adjacent the distal end thereof to a point adjacent the proximal end thereof. The valve is mounted on the sheath adjacent the proximal end thereof, and it has irrigation and drainage ports therein, and it communicates with the interior of the sheath so that it is operative for regulating the flow of fluids between the irrigation and drainage ports and the interior of the sheath. Specifically, the valve has a movable valve element thereon, which is moveable in a single motion between sequential first, second, and third positions, wherein the irrigation port is in communication with the interior of the sheath, but the drainage port is closed, wherein both of the irrigation and drainage ports are closed, and wherein the drainage port is in communication with the interior of the sheath, but the irrigation port is closed, respectively. Hence, because the valve is operative with a single motion between the sequential first, second, and third positions thereof, the flow of fluids to and from the sheath can be precisely and easily controlled by an operator of the device while the operator is viewing an area of the body of a patient through the telescope portion of the device without requiring the operator to look away from the lens of the telescope portion. Hence, the device can be utilized for performing endoscopic operations in the ureter and in other delicate areas of the human body, where the flow of irrigation and drainage fluids must be precisely and delicately controlled in order to prevent damage. In the preferred embodiment of the device of the instant invention, the valve element is rotatable in a single direction for sequential movement between the first, second, and third positions of the valve, and the valve element is preferably mounted on the top portion of the device so that it is easily operable. Further, the valve element is preferably formed with knurls thereon, and it is operative between the first, second, and third positions of the valve by rotating it less than one complete revolution. Accordingly, the valve can be operated by an operator by moving a forefinger along the knurled surface of the valve element on the upper portion of the device to cause the valve element to rotate, and because of the simplicity of this operation, the valve can be operated without distracting the operation's attention from the telescope portion of the device. The endoscopic device of the instant invention is preferably embodied as a ureteroscope and the sheath is preferably embodied as an elongated ureteroscopic sheath having a main portion which includes the proximal end of the sheath and is dimensioned for insertion into a patient so that it extends through the urethra and substantially through the bladder of the patient, and a reduced terminal portion which includes the distal end of the sheath and is dimensioned to be received in the ureter of the patient. Accordingly, when the device is installed in a patient, the valve can be manipulated by an operator by moving a forefinger along the knurled surface of the valve element to effect rotation thereof and to thereby alternatively irrigate or drain fluids from the area of the ureter adjacent the distal end of the device, and because the valve is operable with a single movement of a forefinger, the amount of fluids which are passed into or drained from the ureter can be precisely and safely controlled by the operator. Accordingly, blood, mucus and debris can be flushed from the area of the ureter adjacent the distal end of the device to provide enhanced visualization of the ureter during the performance of surgical and/or diagnostic procedures therein.
Accordingly, it is a primary object of the instant invention to provide an endoscopic device which is operable for effectively controlling irrigation and drainage of the area adjacent the distal end of the device.
Another object of the instant invention is to provide an endoscopic device, wherein the flow of fluids utilized for irrigation and drainage can be controlled with a single movement of a forefinger of an operator of the device.
Another object of the instant invention is to provide an effective uteroscope, wherein the flow or fluids passing into and out of the ureter for irrigation and drainage can be effectively controlled.
Other objects, features and advantages of the invention shall become apparent as the description thereof proceeds when considered in connection with the accompanying illustrative drawings.